The change process and implementation of the First-line Therapies model as experienced by nurses - a qualitative interview study

The First-line Therapies model is a national Finnish initiative designed to improve access to mental health services. It comprises a regionally adapted stepped approach to psychosocial treatment, digital tools to support treatment matching and needs assessment, and training for frontline professionals, in brief evidence-based psychological interventions. In this study, our aim was to examine nurses' experiences of the change process and their perceptions of implementing this new model of care in the City of Helsinki's primary mental health services. The research questions were: (1) How did nurses experience the change process related to the First-line Therapies model? and (2) How did nurses perceive the implementation of the First-line Therapies model?

The study was conducted as a qualitative interview study in 2025. The participants were nurses working in mental health services in primary care under the First-line Therapies model (n = 11). The data were collected through individual interviews in 2025. Inductive content analysis was used in the analysis.

The results of the first research question comprise four categories: (1) More support needed for the change process; (2) The new model of care benefits practical work; (3) Ethical considerations during the change process; and (4) A wide range of emotions. The results of the second research question comprise seven categories: (1) Stepped care system clarifies activities; (2) Stepped care system still poses challenges; (3) Guided self-help prompts different views; (4) Guided self-help needs development; (5) Experiences of method training vary; (6) Therapy Navigator clarifies the assessment of treatment needs; and (7) Digital methods support work but require development.

The First-line Therapies model is necessary and has aided mental health services to better meet the needs of the Finnish population. The model has introduced changes to job descriptions and provided experiences of both success and uncertainty. The stepped care system clarifies activities, and digital tools facilitate work. Personnel should be actively involved throughout any change process and their perspectives should be taken into consideration during the practical implementation of new models of care.